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KEY POINTS
Sepsis is increasing in incidence worldwide. This is the result of a number of factors including: the aging of the population with a large increase in patients more than 65 years; progressive increase in antibiotic resistance; increased reliance on implanted devices, organ transplantation and other invasive surgical procedures; and increasing prevalence of patients with long-term immunosuppressive diseases and medications who are at risk for severe infection and sepsis.
Sepsis is a syndrome consisting of a constellation of signs, symptoms, hemodynamic, and laboratory findings caused by an excessive and/or dysfunctional host immune response to severe infection. There is currently no single diagnostic test sufficient to make a definitive diagnosis of sepsis.
The key to optimal care of the septic patient is early recognition and early initiation of appropriate treatment. This places the responsibility for early recognition on the health care team in managing acutely ill patients. The lack of a rapid diagnostic test and the often subtle initial presentation of sepsis make the early detection of sepsis a real challenge.
Septic shock is a medical emergency and should be treated as such. The major therapeutic approach is aggressive fluid resuscitation, early and appropriate antibiotic therapy, early determination of the source of the causative infection site and source control if possible (drain abscess, remove necrotic tissue or infected catheters or other devices, etc).
The prevention and expert management of organ dysfunction as a result of sepsis is critical for survival and prevention of long-term disability. Expert supportive care by critical care specialists will improve outcomes.
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Sepsis and the multiorgan failure that often accompanies the systemic inflammatory response syndrome (SIRS) is a leading cause of mortality in the intensive care unit. Over 750,000 patients develop sepsis annually in the United States accounting for about 10% of all intensive care unit (ICU) admissions. Of these patients, 5% to 15% will be diagnosed with septic shock. The hospital mortality for septic shock remains approximately 35% to 54%, despite concerted efforts to improve the treatment options and outcome.
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Although modest improvements in the prognosis have been made over the past 2 decades and promising new therapies continue to be investigated, innovations in the management of septic shock are still required. This chapter will describe the molecular pathophysiology of sepsis, current diagnostic and therapeutic strategies, and the management of septic shock.
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New definitions for sepsis were published by the Third International Sepsis Task Force in 2016. According to these updated definitions, sepsis is defined as a life-threatening condition caused by a dysregulated host response to infection accompanied by acute organ dysfunction. Septic shock is a subset of sepsis in which underlying cellular metabolism abnormalities are sufficiently profound to significantly increase mortality. Septic shock is clinically recognized as arterial hypotension, refractory to simple fluid resuscitation, with evidence of hyperlactatemia. Multiple other clinical entities related ...